Healthcare Provider Details

I. General information

NPI: 1841629557
Provider Name (Legal Business Name): CLARENCE ELROD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2013
Last Update Date: 11/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST SCHOOL OF DENTISTRY
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

650 E 25TH ST SCHOOL OF DENTISTRY
KANSAS CITY MO
64108-2716
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7001
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: